Post Publication Independent Review of

"Protecting the psychological health of children through effective communication about COVID-19"

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Post Publication Independent Review of "Protecting the psychological health of children through effective communication about COVID-19"

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Post Publication Independent Review of

Protecting the psychological health of children through effective communication about COVID-19

Louise Dalton, Elizabeth Rapa, Alan Stein

Published: March 31, 2020 DOI:

Review Comments:

1. Quote "In this rapidly changing situation, media and social conversations are entirely dominated by the outbreak, and children are exposed to large amounts of information and high levels of stress and anxiety in the adults around them. Simultaneously, children are experiencing substantial changes to their daily routine and social infrastructure, which ordinarily foster resilience to challenging events.1 End of Quote.

Quote "children as young as 2 years are aware of the changes around them.2 Children's understanding evolves throughout childhood and adolescence. Thus, when adults talk to children, the information provided needs to take into account the child's age and level of understanding. Sensitive and effective communication about life-threatening illness has major benefits for children and their family's long-term psychological wellbeing.2" End of Quote.

The authors point out that COVID-19 management processes will also have to take Children into account.

2. Quote "Children need honest information about changes within their family; when this information is absent, children attempt to make sense of the situation on their own.3 Consideration of the child's developmental stage is crucial to ensure that communication is effective and neither underestimates or overestimates their understanding.4 Communicating with younger children should not solely rely on simplification of the language or concepts used, but must also take into account children's comprehension of illness and causality. " End of Quote.

The authors observation indicates that Communication to Children should also be a part of the COVID-19 management processes. It is not sure whether all parents will have the necessary knowledge and skill to translate health information about a pandemic such as COVID-19 and hand it over to the Children.

3. Quote "listening to what children believe about COVID-19 transmission is essential; providing children with an accurate explanation that is meaningful to them will ensure that they do not feel unnecessarily frightened or guilty." End of Quote.

If this has to be done successfully, then some prior training have to be given to parents via mass media, so that they can interact with the Children, listen to them and read alarm indicators at initial stages itself.

4. Quote "Adults' preoccupation with the implications of COVID-19 might compromise their ability to sensitively recognise and respond to children's cues or distress.7 Children are well attuned to adults' emotional states; exposure to unexplained and unpredictable behaviour is perceived by children as a threat, resulting in a state of anxiety." End of Quote.

These effects may affect the children's psychology and may continue to manifest into their adult life too, as a consequence of accidental or unintentional carry over of anxiety due to threat perception over unexplained and unpredictable behaviour. When the COVID-19 pandemic is exhibiting itself on a global scale, even at the National Level, such phenomena in children is a cause for concern and may need preventive & remedial measures.

5. Quote "Although adults often want to know how children are feeling, adults often do not set an example by sharing some of their own feelings, and conversations might well be dominated by the practical aspects of illness.2 Research has highlighted that parents sometimes specifically use technical or factual language to try and minimise their children's distress.8 An absence of emotion-focused conversations might leave children anxious about the emotional state of the adults around them. This anxiety can inadvertently result in children's avoidance of sharing their own concerns in an attempt to protect others, leaving children to cope with these difficult feelings alone.2"End of Quote.

The authors have provided a rational analysis here. However, the consequence that children are left to cope with difficult feelings alone, may have a significant impact on their psychology.

6. Quote "Adults need to be authentic about some of the uncertainty and psychological challenges of the pandemic, without overwhelming children with their own fears. This honesty not only offers a coherent explanation for what children are observing, but also grants permission for children to safely talk about their own feelings. Normalising their emotional reactions and reassuring children about how the family will look after each other helps to contain anxiety and provides a shared focus." End of Quote.

The authors have pointed out a significant concern. But, adults need to be educated on these aspects and not all adults can be expected to have a sensitive and rational understanding and the ability to convey it to the children. Consequently the burden of educating the Adults regarding interacting with the Children about the COVID-19 pandemic, falls on the Govt. The Govt. has to find ways and means, via mass outreach programs of Television or Social Media to educate the Adults on these sensitive topics.

7. Quote "Providing information9 and prioritising communication with children about COVID-19 is an essential component of any universal, community-led response to the pandemic. Health-care workers are experiencing unprecedented demands caring for a predominantly adult patient population, magnifying the invisibility of children's urgent psychological needs. However, ignoring the immediate and long-term psychological effects of this global situation would be unconscionable, especially for children and young people, who account for 42% of our world's population.10" End of Quote.

The authors are providing the defense here for their analysis, research findings and suggestions given above. When Children make up 42% of the world's population, there arises a priority need to cater to their psychological health, apart from clinical health and related processes. It is this 42% which will soon grow into adults. If the psychological effects of the COVID-19 pandemic are carried by the children into their adolescence and later into their adult stages, the collective effects on the Nation and the World may be devastating.

Consequently, a priority need arises for the Govt. to handle the above concerns related to Children on a war-footing, accompanied with other high priority processes and protocols of the COVID-19 nationwide management.

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